Document ID: A13441 Page: Page 1 of 43
Department: Middlemore Central Last Updated: 09/03/2015
Document Owner: Counties Manukau Health Next Review Date: 31/03/2017
Title: Counties Manukau Health, Health Emergency Plan Date First Issued: 08/04/2010
Prepared: Counties Manukau District Health Board
Executive Summary ... 4
Section 1 General Information ... 5
Introduction ... 5 This Document ... 5 Acknowledgement ... 5 Rationale ... 5 Definition ... 6 Purpose ... 6
The 4R’s of Comprehensive Emergency Management ... 7
Funding Arrangements... 7
Reference Documents and Legislative Requirements ... 7
Scope ... 8
Emergency Management Principles ... 8
Counties Manukau Health Localities ... 9
The area to which this plan applies ... 9
Counties Manukau Health District Map ... 10
Population Demography ... 10
Population Composition ... 11
Population Growth ... 11
Key Objectives and Guiding Principles ... 11
New Zealand Health Emergency Management Framework ... 12
Civil Defence Emergency Management Framework... 13
Section 2 Reduction ... 15
Introduction ... 15
Comprehensive Risk Assessment ... 15
Ongoing Risk Identification ... 16
Key Stakeholders ... 17
Northern Region Health Coordinating Executive Group (NRHCEG) ... 17
Auckland Regional Public Health Service (ARPHS) ... 17
Primary Health Organisations (PHOs) ... 18
Civil Defence Emergency Management Group (CDEMG) ... 18
Section 3 Readiness ... 19
Introduction ... 19
Health Major Incident Plan (MIP – Operational) ... 19
Service Specific Emergency Plans ... 19
Flipcharts ... 19
Training ... 20
Exercises ... 20
CDEM National Exercise Programme ... 20
Core Performance Indicators ... 21
Section 4 Response ... 22
Introduction ... 22
Response to a Health Emergency ... 22
Planning for Recovery ... 22
Capability and Capacity ... 23
Coordinated Incident Management System (CIMS) ... 23
Emergency Operations Centre (EOC) ... 24
Communications ... 24
Alternate Communications ... 24
Emergency Management Information System (EMIS) ... 25
Single Point of Contact (SPoC) ... 25
Health and Safety of Employees ... 25
Health Sector Alert Codes ... 26
Surge Capacity ... 26
Activating the Northern Region HEP ... 26
Emergency Ambulance Communication Centre ... 27
Health Related Roles and Resources ... 29
Non-Governmental Organisations (NGOs) ... 29
Volunteers ... 29
Spontaneous Volunteers ... 29
Maori (Maaori) Health ... 29
Pacific Health ... 29
Vulnerable People ... 30
Standing down the HEP ... 30
Section 5 Recovery ... 31
Introduction ... 31
Recovery Objectives ... 31
CM Health – A Whole System Approach ... 31
Psychosocial Recovery ... 32
Recovery Activities ... 32
Organisational Debriefing ... 32
Appendices ... 34
Appendix 1: Abbreviations ... 34
Appendix 2: Key Roles and Responsibilities (National CDEM Plan) ... 35
Appendix 3: Health Emergency Planning Partnership ... 40
Appendix 4: Distribution List ... 41
Appendix 5: Roles and Responsibilities by Alert Code ... 42
The Chief Executive of Counties Manukau Health supports the Emergency Management Coordination activities detailed in this plan.
The Operational Policy Framework from the Ministry of Health (MoH) requires every DHB to have a Health Emergency Plan (HEP). The HEP has been developed to provide a consistent approach to coordination, cooperation and communication across the health sector when responding to an incident. The HEP aims to manage a resilient and sustainable health sector.
The 2014 CM Health HEP is an updated version of the first plan written in 2008. Since that time significant events have occurred both internationally and nationally that reinforce the need for cooperation and alignment throughout the health sector, emergency services and the community we serve.
The HEP covers the 4 R’s of Emergency Management which are: Reduction Risk identification and analysis
Readiness Development of operational systems and capabilities Response Immediate action
Recovery Coordinated effort for restoration of core services
This HEP outlines the structures in existence that provide for the best possible response with appropriate use of resources in the quickest time frame to ensure safety of all people involved. Counties Manukau Health works in partnership with 4 key agencies:
The Northern Regional Health Coordinating Executive Group (HCEG) along with Northland, Waitemata and Auckland District Health Boards.
Civil Defence Coordinating Executive Group (CEG)
Emergency Services Coordinating Committee (ESCC) along with Police, NZ Fire and St John.
Auckland Airport Ground Safety Meeting along with Airport services, Police, Fire, St John, Red Cross, Air New Zealand, Ministry for Primary Industries (MPI) and the Coastguard. There are multiple plans referred to within this document, they are not contained in the document but can be found on the Ministry of Health website: http://www.health.govt.nz and a hard copy of each of these plans can be found in Middlemore Central, Middlemore Hospital.
The compilation of this documents information has been sourced and used from Northern Region DHBs (Northland, Auckland and Waitemata), Waikato DHB, The Ministry of Health, Primary Health Organisations, Public Health, and a selection of key stakeholders.
The overarching goal of the Counties Manukau Health, Health Emergency Plan is to ensure resilient health services in the Counties Manukau region and a sustainable health sector during any potential or significant health or civil emergency.
Section 1 General Information
Emergencies can happen anywhere and at any time. They can be caused by severe weather, infectious diseases, industrial accidents or intentional destructive acts. The very nature of an emergency is unpredictable and can change in scope and impact. When an emergency happens it can threaten public safety, the environment, the economy, critical infrastructure and the health of the public.
Emergency preparedness is progressive, continuously moving the public and local agencies towards greater resilience. This ongoing progression involves careful planning, designing of
response actions, testing and evaluating the process and updating the plans. To ensure continuing resilient health services, during any potential or significant health or civil emergency careful
planning is critical to protecting the public and healthcare providers and safe-guarding the public’s investment in the healthcare system.
The Counties Manukau Health Emergency Plan (HEP) is a strategic document that establishes the link with specific national, regional and local Health Emergency plans and procedures. The CM Health, HEP is on the CM Health website.
The Counties Manukau Major Incident Plan (MIP) is the operational plan that is activated
whenever a major incident occurs and is on the Counties Manukau Health intranet (SouthNET). The term “Health Emergency Plan” embraces the plan for significant incidents and emergencies referred to in paragraph 30 (s1) of the National Civil Defence Emergency Management Plan Order (2005).
This plan has been created with input from the Northern Region DHBs (Northland, Auckland and Waitemata), Waikato DHB, The Ministry of Health, Primary Health Organisations, Public Health, and a selection of key stakeholders.
The Counties Manukau Health, HEP has been developed as a requirement of the Ministry of Health (MoH) Operational Policy Framework (OPF) for District Health Boards. The OPF is one of a group of documents, collectively known as the “Policy Component of the District Health Board Planning Package”, that sets out the accountabilities of District Health Boards (DHBs). The CM Health, HEP has been developed to provide a consistent approach to coordination, cooperation and
communication across the health sector when responding to an incident.
Under the National Civil Defence Emergency Management Plan Order (2005) (National CDEM Plan) and the Crown Funding Agreement, all DHBs and their respective Public Health Units (PHUs) are tasked with developing their own emergency response plans. These plans apply the structures and processes identified in the National Health Emergency Plan (NHEP) by district and region and are required to identify how services will be delivered in a civil defence or related emergency and acknowledge the role of the DHBs as both funder and provider of health services.
The National CDEM Plan required DHBs to provide adequately for public, primary, secondary, tertiary, mental and disability health services. DHBs shall cover an integrated and regional response and be coordinated with plans of other agencies for example ambulance, fire, police, local authorities and Civil Defence Emergency Management Groups (CDEMGs). In their response to an emergency incident DHBs must use the Coordinated Incident Management System (CIMS), which forms the basis of operational response in New Zealand.
Emergencies occur continually in health and the health and emergency services respond
accordingly. The criterion used to activate a Health Emergency Plan is when “usual resources are overwhelmed or have the potential to be overwhelmed”.
The concept of being overwhelmed will be used throughout this HEP without a detailed definition to allow flexibility in the assessment of a pending, developing or current emergency on an hour by hour or day by day basis (use of the term emergency is based upon Civil Defence Emergency Management Act (CDEM Act ) definition, 2002 Pt 1, s4).
A health emergency is defined as any event which:
Presents a serious threat to the health status of the community
Results in the presentation to a healthcare provider of more casualties or patients in number, type or degree than is staffed or equipped to treat at that time
Loss of services which prevent a healthcare facility or service from continuing to care for their patients
The health emergency plan may be activated at a local, regional or national level, when the incident controller regional or national coordinator believes that a situation exists that is, or has the potential to overwhelm the resources available to respond to the emergency.
The purpose of the Plan is to illustrate the emergency management arrangements in place at national, regional and local levels to maintain a resilient and sustainable health sector during any potential or significant health or civil defence emergency.
The HEP will incorporate generic CM Health information; it does not contain service specific plans but refers to them.
The HEP aims to create a framework to manage a resilient and sustainable health sector during any potential or significant health emergency by planning for:
The reduction of impact consequences (established by hazard analysis) on facilities and supplies
Continuation of care of existing patients/clients, and provision of normal services to the fullest possible extent, should facilities or services be disrupted
Activation of available resources to meet either a slow but sustained rise in demand such as a Pandemic or sudden rise in demand
Alternate facilities and sources of supply
Communication between health providers prior to, during and after an emergency
Staff training in health related emergency roles and responsibilities
Care of staff during an emergency.
The 4R’s of Comprehensive Emergency Management
The CM Health, HEP describes the rational and purpose of how the plan is aligned with regional and national health emergency plans and incorporates the 4 R’s of comprehensive emergency management which are:
Reduction – risk identification and analysis to human like and property from natural or man-made hazards.
Readiness – developing operational systems and capabilities before an emergency
happens, including self-help and response programmes for the general public and specific programmes for emergency services and other agencies.
Response – actions taken immediately before, during or directly after an emergency, to save lives and property, prevent the spread of disease as well as help communities recover.
Recovery – begins after the initial impact of the response and extends until business can continue and services restored.
The requirement for Counties Manukau Health to develop and maintain a Health Emergency Plan is stipulated in its Crown Funding Agreement.
During response and recovery activities providers must document their response actions and keep a record of all costs incurred during response and recovery activities. Costs should first be billed through normal or per-arranged funding agreements.
For DHB incidents, DHBs will cover the costs of a major incident up to 0.1% of its allocated budget. Following that, costs will be recovered via application to the Ministry of Health or, if relevant, the Ministry of Civil Defence Emergency Management.
In order to assist with tracking of costs associated with the response, an emergency cost centre has been set up by the DHB to be used during an emergency event.
Reference Documents and Legislative Requirements
The HEP meets the following requirements:
Health (Burial) Regulations 1946
Health Act 1956
Health (Infectious and Notifiable Diseases) Regulations 1966
Medicines Act 1981
Health (Quarantine) Regulations 1983
NZ Public Health and Disability Act 2000
Civil Defence Emergency Management Act 2002
International Health Regulations 2005
Epidemic Preparedness Act 2006
The health section of the National Civil Defence Emergency Management Plan Order, 2005 (latest published version)
The National Health Emergency Plan (NHEP)
The National Health Emergency Plan: Guiding Principles for Emergency Management Planning in the Health and Disability Sector, 2005
The National Health Emergency Plan: Burn Action Plan
The National Health Emergency Plan: Mass Casualty Plan
The National Health Emergency Plan: Hazardous Substances Incident Hospital Guidelines, 2005
The National Health Emergency Plan: National Reserve Supplies Management and Usage Policies (latest published edition)
The New Zealand Influenza Pandemic Action Plan (latest published version)
The Environmental Health Protection Manual
The Law Reform (Epidemic Preparedness) Bill (2006)
Health and Disability Standards (2008) Part 4.7; ‘Essential emergency and security systems’
Auckland Civil Defence Emergency Management (CDEM) Group Plan
Any other published National Health Emergency Planning documents or guidelines
The CM Health, HEP incorporates national and regional planning and information. It encompasses all sectors across Counties Manakau Health including:
Counties Manukau Health Hospital Services
Counties Manukau Community Services
Counties Manukau Support Services
The HEP emphasises the importance of an integrated effort. It includes strategic alliances and partnerships that enable effective planning and response to all hazards that may result in an emergency response by the health sector.
Emergency Management Principles
The National Civil Defence Emergency Management Strategy 2007 (CDEM) stipulates that an all hazards, all risks. Multi-agency, integrated and community focused approach is central to emergency management in New Zealand.
The strategy outlines that the New Zealand integrated approach to Civil Defence Emergency Management can be described under the four key areas, reduction, readiness, response and recovery.
Counties Manukau Health Localities
Counties Manukau Health has 7 inpatient sites which are:
Manukau Health Park (Manukau Super Clinic, Manukau Surgery Centre)
Auckland Spinal Rehabilitation Unit
Franklin Memorial Hospital
The New Zealand National Burn Centre is situated at Middlemore Hospital
The area to which this plan applies
The area encompassed by this plan is made up of the three local territorial authorities of Manukau City, Papakura and Franklin Districts.
The northern boundary of Manukau City runs from the Tamaki Estuary along the boundary between the Auckland Golf Course and Kings College and north along Hospital Road to Westfield Railway Station.
Counties Manukau Health District Map
The population of CM Health can be mapped according to the locality in which people live (their residential locality). In addition to residential localities, the population can also be mapped according to where they are enrolled for primary care services. This can be termed an ‘enrolled population’ view of CM Health. The extent to which the resident populations and enrolled populations differ varies across the residential localities of CM Health. For the development of localities for health service provision, the CM Health enrolled population will be divided into four localities. The boundaries for these localities take into account primary care provider affiliations and networks of interest as well as the physical address of primary care services. The service localities will essentially comprise:
Mangere/Otara (including northern Papatoetoe),
Eastern (Howick plus the Maraetai/Beachlands and Clevedon),
Information specific to each locality across the Counties Manukau District is available under the
Localities Planning section.
Counties Manukau has high numbers of Maaori*, Pacific and Asian people and a relatively youthful population.
Twenty-four percent of the population is aged 14 or under; 14% of New Zealand children live in Counties Manukau.
Counties Manukau has a high birth rate compared with many other areas, this contributes to relatively high demand on our maternity and child health services.
The CM Health, HEP incorporates national and regional planning and information to ensure consistent approach and encompasses all sectors across Counties Manukau Health including:
CM Health Hospital Services
CM Health Mental Health Services
CM Health Spinal Unit
CM Health Community Services
National Burns Centre
The Counties Manukau Health population is growing at 1.5-2% per annum, an additional 8,000-9,000 residents predicted per year. The estimated population aged 65 and over is projected to more than double from 39.830 in 2006 to 90,170 by 2026 (53,610 in 2013).
Key Objectives and Guiding Principles
The National CDEM Plan requires DHB’s to ensure that they are able to function to the fullest possible extent during and after an emergency by ensuring the following:
The emergency management structure provides a consistent and effective response at a local, regional and national level.
The emergency management structure supports, to the greatest extent possible, the protection of all health service workers, health and disability service consumers.
Support for services that are best able to meet the needs of patients/clients and their community during and after an emergency event even when resources are limited.
Planning that adopts an all hazard approach and considers all natural and man-made hazards and risks.
Plans for all health and disability providers in the provision of welfare to their own staff who are affected by the emergency, including those operating during it.
New Zealand Health Emergency Management Framework
The Ministry of Health National Health Emergency Plan (NHEP) provides overarching direction for the health and disability sector and all of government. The NHEP:
Outlines the structure of emergency management in New Zealand and how the health and disability sector fits along with it, and provides a high-level description of responsibilities held by local and regional groups compared to those held at the national level by the Ministry of Health.
Provides the health and disability sector with guidance and strategic direction on its approach to planning for and responding to health emergencies in New Zealand.
Provides other organisations and government agencies with contextual information on emergency management in the health sector and the structure the health and disability sector uses in the response to an emergency.
The relationship between DHBs, HEPs, NRHEP and the NEHP is illustrated below:
Guiding principles for emergency management in the
health & disability sector
National Human Resources Pandemic Guidelines Hazardous substances incident
Planning for individual and community recovery in an
Getting through together Ethical values for a pandemic
National Health Emergency
New Zealand Influenza Pandemic Action Plan
National Multiple Burn Action Plan
Future Action Plan
Northern Region Health Emergency Plan Midland Region Health Emergency Plan Central Region Health Emergency Plan Southern Region Health Emergency Plan Northland DHB HEP Auckland DHB HEP Counties Manukau DHB HEP Waitemata DHB HEP
Civil Defence Emergency Management Framework
National Civil Defence Emergency Management (CDEM) planning in New Zealand is a requirement of the CDEM Act (2002), and is included in the latest National CDEM Plan.
The CDEM Act specifies the role and function of CDEM organisations and the role of government organisations. It includes:
Planning for emergencies
Declaration if a state of local or national emergency
Local authority mayors (or delegated representatives) or the Civil Defence Minister can declare a state of local emergency
The Civil Defence Minister can declare a state of national emergency
Emergency powers that enable CDEMGs and CDEMG controllers to:
Close/restrict access to roads and public places
Provide rescue, first aid, food and shelter
Conserve essential supplies and regulate traffic
Dispose of dead persons and animals
Enter into premises
Evacuate premises / places
Requisition equipment/materials/facilities and assistance.
National emergencies are managed by a lead agency, which may be assisted by support agencies. For a civil defence emergency the lead agency is the Ministry of Civil Defence and Emergency Management (MCDEM). MCDEM will use the arrangements in the National CDEM plan to manage the adverse consequences of an event. For a civil defence emergency at the local level, the lead agency is a CDEM.
A range of other government agencies rather that MCDEM may take the lead in an emergency. If MCDEM determined that an emergency was more appropriately managed by another government agency e.g. the Ministry of Primary Industry in the advent of a biological emergency, then it is likely that Government would ask Ministry of Primary Industry to become the lead agency. Section 9.30+31 of Guide to the National Civil Defence Emergency Management Plan defines the key role and responsibilities of the DHB and the Public Health Unit.
The development, maintenance and exercising of the HEP ensures that essential primary,
secondary, tertiary, mental health, disability support and public health services will continue to be delivered and prioritised during health emergencies, civil defence emergencies, large casualty causing incidents, major weather events or natural disasters.
Section 2 Reduction
The principles of reduction are to identify and analyse risks that are significant due to the likelihood of consequence to human like or property from natural or manmade hazards. Having identified and analysed the risks, steps are taken to eliminate these risks where practicable and where not, to reduce the likelihood of the impact.
Many events have the potential to become a health emergency. These may result in one or more providers being potentially or actually overwhelmed. Each emergency brings its own individual conditions. Emergency events can escalate to the point where they will impact on the health sector’s ability to provide health and disability services.
Comprehensive Risk Assessment
The HEP provides for both immediate, short duration events and extended emergencies, on both small and large scales as relevant to the CM Health population.
Risk results when hazards negatively interact, or have the potential to negatively interact with communities. Risk is therefore the sum of a hazard and the elements of the community that are vulnerable to that hazard.
For example, an earthquake is a hazard but is only a risk if it affects people, buildings etc (vulnerable elements).
Risk = Hazard x Vulnerability
Risk can also be considered as the likelihood of harmful consequences arising from the interaction of hazards with the community and the environment.
Risk = Likelihood x Consequences
The risks identified will have implications for the health sector. These may include the following:
Stretched medical services
Widespread social and psychological disruption and isolation
Strain on public health resources
Reliance on primary care providers to undertake initial treatment and triage of injured of affected groups
Requests made from the NGO sector for hospital staff assistance
Medical supplies not readily available (demand exceeds supply).
Mass casualty events will require significant planning both locally and regionally. These risks are addressed across the emergency management planning process at CM Health and include actions to ensure a state of readiness for health emergencies. Taking a multi hazard approach which incorporates the Auckland Region CDEMG risk register formed the basis for the CM Health risk analysis. More information can be found on Auckland CDEMG Plan 2011-2016.
The table below shows high and very high hazards, the priority risk rating analysis as determined by assessing residual risk Hazard priorities for the Auckland region have been taken from the Auckland Region CDEMG Plan. Specific threats not impacting on healthcare services or involving a health sector response have been removed.
Likelihood Consequence Risk Rating
Lifeline utility failure: Electricity
Possible Catastrophic Very High
Human Epidemic Possible Catastrophic Very High
Volcanic eruption: distant source eruption
Likely Major Very High
Cyclone Likely Major Very High
Flooding: River/Rainfalls Almost certain Moderate Very High Erosion: Coastal
Almost certain Moderate Very High Volcanic Eruption: Auckland
Rare Catastrophic High
Animal Disease: Epidemic Possible Major High
Crash: Aircraft Possible Major High
Earthquake Unlikely Major High
Hazardous substance spill Likely Moderate High
Lifeline Utility Failure: Water Supply/Waste Water
Possible Moderate Moderate
Lifeline Utility failure: Communications
Possible Moderate Moderate
Crash: Rail Possible Moderate Moderate
Flooding: Tsunami (regional/local)
Unlikely Moderate Moderate
Crash: Road Likely Minor Moderate
Fire: Urban Possible Minor Moderate
Health hazard priority risk rating analysis determined by assessing residual risk Hazard priorities for the Auckland Region as per the Auckland Region CDEM Plan (2011).
Ongoing Risk Identification
CM Health participates in local and national level disaster preparedness exercises with multiple agencies in order to ensure risk identification and disaster responses are current.
CM Health emergency response procedures were tested during Exercise Train Wreck in 2011 (mass casualty exercise) and Exercise Chopper in 2014, (mass casualty and evacuation exercise). The scope of these exercises included widespread service engagement across the organisation at an operational level to test the organisations Major Incident Plan and Service Specific Emergency Plans. During these respective exercises, service plans were validated, gaps identified and plans reviewed.
Key stakeholders engage on a regular basis via scheduled meetings to build relationships, network, share information and provide updates which enables a clear understanding of agency roles and obligations during an emergency. Links to, and alignments with the following agencies:
Emergency Management Committee (EMC)
Auckland Airport Ground Safety Group
Northern Regional Health Coordinating Executive Group (HCEG) along with Northland, Waitemata and Auckland District Health Boards.
Auckland Region Civil Defence Emergency Management Group (CDEMG) & Coordinating Executive Group (CEG)
Emergency Services Coordinating Committee (ESCC) along with Police, NZ Fire and St John.
Auckland Region Public Health Service, Ministry of Health, Police, Fire, St John Ambulance, Civil Defence, Auckland Airport, Auckland Transport, WorkSafe NZ, Corrections, Red Cross, Air New Zealand, Ministry for Primary Industries (MPI) and the Coastguard.
Northern Region Health Coordinating Executive Group (NRHCEG) – is responsible for coordinating emergency management planning activities across the Northern Region (as defined in the National Health Emergency Plan). The objective of this group is to: “Ensure the effective coordination of health sector emergency management reduction, readiness, response and recovery for the Northern Region”.
The term Health CEG is used to draw a parallel between the functions of the regional health sector CEG within the sector and the Northland Region CDEM CEG with the broader emergency
management sector. The Health CEG is responsible to the DHB’s CEO’s.
The Terms of Reference for the Health CEG includes: “identifying areas of health emergency management in the Northern Region in which planning coordination is necessary or desirable to optimise health sector reduction of, readiness for, response to and recovery from health
The Health CEG is a strategic level group and provides a regional focus to emergency planning in the health sector. Encompassing all health agencies within the Northern Region its membership consists of:
Senior Manager from each DHB (4)
District Health Board Emergency Manager (4)
St John Ambulance representative
Auckland Regional Public Health Service (ARPHS) representative
Primary Health representative
Ministry of Health representative
Ministry of Civil Defence Emergency Management (MCDEM) representative
Maori Health representative
Pacific Health representative
Auckland Regional Public Health Service (ARPHS) – ARPHS have a representative on the Northern Region Health Coordinating Executive Group where relationships are well established with
monthly meetings and regular updates. ARPHS emergency activities include pre-disaster planning, emergency response, regulatory activities and interagency liaison with the Auckland Region Civil Defence Emergency Groups, Council environmental health officers, emergency services, lifeline utilities and regional/national health stakeholders and communities to ensure public health aspects of emergency planning are considered and integrated into emergency plans.
Primary Health Organisations (PHOs) – CM Health funds a number if primary health care services provided through Primary Health Organisations (PHOs), general practises and a wide range of community based providers and other organisations that provide first point of contact to primary health care related services, pharmacies, laboratories. Emergency management is a function that requires collaboration across many agencies including DHBs, PHO, general practises and the MoH. Regional health emergency coordination issues are currently managed through Health CEG with a mandate from DHB CEOs. Emergencies that potentially affect hospital services must link with primary care services.
Civil Defence Emergency Management Group (CDEMG) – has the overall responsibility for the provision of CDEM in the Auckland region and works in partnership with emergency services and other organisations to ensure the effective delivery of CDEM functions which are described in Section 17 of the CDEM Act 2002. Supporting the CDEMG is the Coordinating Executive Group (CEG), which is a statutory group comprising senior representatives of the Auckland Council and the CDEM member organisations. It provides a strategic overview of CDEM in Auckland and is able to commit the resources of the representative organisation to agreed projects and tasks.
Section 3 Readiness
Readiness involves planning and developing operational arrangements before an emergency happens. It includes consideration of Response and Recovery. All systems need to be developed, tested and refined in readiness for an efficient and effective health sector response to a potential emergency. There are national agencies, groups and plans that all assist the state of readiness required to manage a disaster situation. The information in this section identifies groups that the health emergency planner engages with, and the processes for ensuring that the DHB is prepared to meet all requirements during a disaster.
Health Major Incident Plan (MIP – Operational)
CM Health is responsible for the health and wellbeing of its community. To achieve this, planning and preparing for all events is necessary for services to continue to deliver to adequate standards within appropriate timeframes.
The Major Incident Plan (MIP) provides a framework to assist in the management, coordination and control of major incidents. The MIP provides the procedures to manage an incident at an operational level and includes:
An Activation pathway
Actions and responses
MoH Alert codes
Major Incident Communication Plan
Coordinated Incident Management Systems (CIMS)
Key organisational actions and responses
Rapid Discharge procedures
Staff Cascade procedures
The threshold for activation/escalation will be determined by the level of impact (actual or potential) that an emergency has on CM Health. The MIP’s flexibility allows for the level on implementation to vary according to the nature of the incident. The MIP incorporates the principles of the Coordinated Incident Management Systems (CIMS) model adopted by the other emergency services and lifeline organisations as per the CDEM Act (2002).
Service Specific Emergency Plans
Services throughout CM Health have in place, specifying the operational aspects of their
department/service to respond to a major incident. The plans include services provided, ward / department profiles, equipment inventory, contingency plans, leadership structure, staff actions and responsibilities, creating capacity and cascade call back procedures. These plans are intended to be read in conjunction with the Major Incident Plan.
Flipcharts are available throughout CM Health sites. The flipcharts give advice to staff and members of the public for the following situations:
Essential utility failure
Hazardous material alert
Threat to personal safety
Suspicious activity /unwelcome visitor or media
Bomb threat/suspicious object
Medical/Surgical emergency calls
Newly appointed staff attend an induction and orientation day (Welcome Day) which includes information on the principles of emergency management. Staff are encouraged to access their Service Specific Emergency Plan which is easily accessible on the CM Health intranet (SouthNET). Senior staff and Executive/Personal Assistants are encouraged to attend a Health CIMS course that is run a number of times a year, which gives an overview of emergency response procedures, equipment, and resources. Executive/Personal Assistants are also trained in Emergency
Management Information System (EMIS) a communication tool used by the Ministry of Health and all DHBs.
General Managers, Service Managers and staff most likely to be part of the Incident Management Team have been CIMS 4 trained which is provided by Auckland Civil Defence (Auckland Council). Emergency Response procedures are tested throughout the year and plans/procedures updated.
CM Health is committed to exercising the emergency preparedness and response procedures to the fullest extent possible. On occasion, the timing of exercises might not be ideally suited to link with routine work requirements of the DHB but participation in all exercise receives high priority. Participation in exercises is essential for ensuring the best service to the public throughout the time of an emergency. Emergency events can occur without warning, the extra workload that is integral to exercise participation has positive outcomes at an individual, team, organisational and inter-agency level.
CM Health participates in all national Ministry of Health, Ministry of Civil Defence & Emergency Management and local DHB exercises. They provide opportunities to test systems and networks within the sectors and provide learning opportunities in respect to internal and inter-agency collaboration and cooperation.
Dependent on the type of event there may be members of Emergency Services present, Primary Health representative and Civil Defence personnel if required.
CDEM National Exercise Programme
The national CDEM exercise programme provides a mechanism by which the operational capacity and capability of government agencies including the health sector, lifeline utilities,
Non-Governmental Organisations (NGOs) and CDEMs can be assessed. Other mechanisms such as debriefs and reviews also contribute to this understanding.
Core Performance Indicators
Participating in local, regional and national exercises helps CM Health to ensure that it delivers on its commitments and is able to identify opportunities for improvement. It is essential to monitor the performance of its emergency management procedures and key processes. Core performance indicators of assessing capacity and capability are that:
Effective communication is maintained at all times.
Emergency plans are maintained and exercised.
Work is prioritised effectively.
Response and recovery objectives are achieved without unexpected delay.
Logistics, transport, contract and supply requirements are addressed.
Resources are used efficiently and conflicts over deployments are avoided.
Gaps in capacity or capability are identified and resolved.
All functions are sufficiently resourced with appropriately trained staff.
There is clarity among agencies about roles, responsibilities or actions.
The testing and exercising of the plans and implementation of lessons identified provides for continuous improvement.
Section 4 Response
Response involves those actions taken immediately before, during and after an emergency to save lives. It also involves helping communities to recover by mobilising and deploying health
resources immediately prior to, or during an emergency, in collaboration with other services and agencies by doing the following:
The continuation of essential health services
The relief and treatment of people injured or in distress as a result of the emergency
The avoidance or reduction of ongoing public or personal health risks to all those affected by the event.
CM Health response describes how essential primary, secondary, tertiary, mental health, disability support and public services will continue to be delivered during the response phase. It outlines how the plan is utilised and the thresholds for activation/escalation, followed by the actions taken at local and regional levels.
Response to a Health Emergency
In a health related emergency i.e pandemic, the Ministry of Health are the lead agency. The Director-General of Health on behalf of the Minister of Health has overall responsibility for health and disability matters in all phases of emergency management. The role of the Ministry is to coordinate the operational emergency response. The Ministry will initiate and coordinate any national emergency response for the health sector.
Planning for Recovery
Recovery activities commence while response activities are still in process. The priority actions for each are different: however, decisions made during the response phase will have a direct
influence on recovery action planning.
The structure used when the Ministry is the national lead agency at the operation level.
Health Response Structure MCDEM
Northern Region Health Coordination/NRHCC Counties Manukau Health Auckland CDEM Controller Ministry of Health Auckland DHB Public Health Units Northland DHB Waitemata DHB St John
Major Incident Plan (MIP) alignment with the HEP
CM Health MIP defines a major incident as an:
Internal Major Incident is an event occurring within CM Health resulting in disruption to normal activities.
External Major Incident is an event occurring that impacts on the health sector resulting in disruption to normal activities.
Examples of a major incident may include but are not limited to the following:
Major epidemic or pandemic
An event involving mass casualties
Terrorist threat (includes bomb threat requiring evacuation)
Loss of essential services (including communications failure to blackouts)
Critical staff shortage (including strikes)
Reduced operational capability of neighbouring DHB
Natural disaster e.g volcanic eruption.
Activation of the MIP is reliant on an assessment of the presenting situation by key personnel and departments. A formal handover of responsibility from the Duty Manager to a designated
Hospital Incident Controller will be completed. Some events will be initiated from outside the hospital environment and may be managed from the outset by the designated hospital Incident Controller. Notification is an essential element on the activation process and will depend on established channels of communication. Any emergency incident or potential crisis that may overwhelm normal resources has to be escalated by staff using the process described in the MIP.
Capability and Capacity
New Zealand’s overall capacity and capability is made up of combined national and local resources that in some circumstances may be augmented by international assistance. Central and local government both have roles in terms of providing capacity and capability. Certain situations are clearly the responsibility of central government – MoH and MCDEM, while other involve central government working with local government agencies- Northern Region DHBs, Auckland and Northland local authorities. The exact boundaries are a reflection of scale and scope and may develop over time. Central government has a significant role in providing resources to support CDEMGs in the management of emergencies.
Coordinated Incident Management System (CIMS)
The Coordinated Incident Management System (CIMS) is a model adopted in New Zealand for the coordination of an incident; it forms the basis of the operational response. All emergency services use a CIMS structure to staff their emergency operating centres (EOCs).
CIMS is consistent at all operational levels operating within the health and disability sector during an emergency. As a nationally adopted tool, CIMS has been implemented by Counties Manukau Health. It is intended to provide a structure allowing multiple agencies involved in an emergency to work together as a team. The CIMS structure does not affect the normal day to day operation within CM Health and other health agencies. Normal clinical, managerial and other relationships are maintained within agencies involved in a response.
The Incident Management Team (IMT) assists the hospital incident controller by providing advice and specialist knowledge, and handling detailed work. The members of the incident management team are shown below. In addition to the CIMS function managers, the incident management team may include:
A Response Manager
Technical experts with knowledge relevant to the incident, and
Incident Management Team
Emergency Operations Centre (EOC)
An emergency operations centre (EOC) is where the Hospital Incident Controller and IMT manage the response from. The EOC may be as small as a single desk or as large as the situation calls for. Events may last a few hours or a few months
The CM Health Emergency Operation is situated in Middlemore Central, Level 2, McIndoe Building, Middlemore Hospital. The primary role of the Incident Management Team is the coordination of the response to an incident affecting CM Health. The incident will determine the response set up i.e. if the event is of short duration the Hospital Incident Controller may be the Duty Manager.
The aim is to keep key stakeholders informed by communicating relevant information about the Incident, via appropriate channels at regular intervals
In an emergency response a formal communication structure is required to be used by key health agencies such as DHBs and Ambulance with the MoH so that critical information is captured and acted on quickly and effectively. The key areas that require a formal structure include:
Logging information and tracking tasks
Requesting information or action and tracking response
Developing and disseminating reports on the current situation (Situation Reports)
Summarising and communicating key intelligence on the incident.
Alternate communications channels as follows:
Hospital Incident Controller
Technical Experts Risk – safety, legal
Planning Manager Operations Manager Logistics Manager PIM Manager Welfare Manager
Paper based templates
Satellite phones x 2 Email, fax Internal Radio Transmitter x 8 Cell phone x 44 Email, fax Pager
Emergency Management Information System (EMIS)
EMIS is a web based emergency management system hosted by the Ministry of Health and provided to the New Zealand health sector in order to manage local, regional and national emergencies. EMIS compliments existing business as usual systems (EpiSurv and patient management systems). Whilst the focus is on the health sector, it is also intended to facilitate structured information sharing with local, regional, and national partners. The system also provides electronic links between emergency websites.
Health EMIS provides each DHB, PHU and other key health responders such as Ambulance, with logging and task tracking system, in order to manage their response to an incident. There is a formal set of standards and processes governing the development of the NZ health sector EMIS. Access to the system is limited to emergency response trained staff.
Single Point of Contact (SPoC)
The Single Point of Contact (SPOC) approach is a communication method that is used to provide an effective contact 24 hour, seven days a week system. The SPOC system connects the Ministry of Health, Ministry of Civil Defence & Emergency Management, DHBs nation-wide and DHB public health units. In line with the requirements of the MoH NHEP, the nominated Counties Manuaku Health SPOC for any national health related emergency is the Middlemore Central Duty Manager, which includes Emerging Infectious Disease alerts. The primary response management of an emergency lies with the affected local provider, CM Health or the Northern Region Health CEG if the Regional HEP is activated. In addition, St John has the capability to alert and notify the Northern Region Health Sector, this system is tested regularly.
Health and Safety of Employees
Health and safety of employees is pivotal to a successful response, this include consideration of the following:
Maintaining a safe environment
The health and safety role in the IMT will be responsible for ensuring that all the practical steps are applied to the general duties that are carried out by staff and volunteers during an emergency as outlined in the Health and Employment Act 1992. This includes, but is not limited to, ensuring the employees and other people where appropriate have access to:
Personal Protective Equipment (PPE) and decontamination equipment
Supplies for treatment for anyone who may be exposed to infectious diseases, e.g. antibiotics
Facilities to ensure their physical and mental wellbeing throughout the response phase
Any other protective measures practical to provide
Health Sector Alert Codes
The MoH has developed alert codes to provide a system of communication for an emergency that is easily recognised within the sector. These alert codes are issued via the Single Point of Contact (SPoC) system.
The alert codes outlined below have been adopted for use by the health and disability sector at district, regional and national levels.
PHASE EXAMPLE SITUATION ALERT CODE
Information Confirmation of a potential emergency that may impact in and/or on New Zealand. For example, a new infectious disease with pandemic potential, early warning on volcanic activity or other threat.
Standby Warning of imminent Code Red alert. For example, a possible emergency
in New Zealand such as an imported case of a new and highly infectious disease in New Zealand without local transmission of initial reports of a major mass casualty event within one area of New Zealand which may require assistance from outside the affected region.
Activation A major emergency exists in New Zealand requiring immediate activation of HEPs. For example, a large scale epidemic or pandemic or major mass casualty event requiring assistance from outside the affected region.
Stand down Deactivation of the emergency response. For example, end of outbreak, epidemic or emergency. Recovery activities will continue.
Health Sector Alert Codes
In response to complex emergencies there may be a need for DHBs to safely decant or/and evacuate health facilities ensuring that patients will be able to continue to have access to health care. Three aspects need to be considered when planning surge capacity:
Early transfer or discharge of current patients to other areas. Alternative areas in which to manage patients requiring admission. Cancellation of patient clinics and elective services.
Evacuating patients from facilities where services has been lost or severely reduced
Deployment of staff from one area to another in order to provide assistance during a response.
Activating the Northern Region HEP
The Northern Region HEP provides an agreed framework, guiding principles and the roles and responsibilities to enable a coordinated response to any emergency (actual or potential) which has overwhelmed (or the potential to overwhelm) local, regional or national health capacity.
Links with regional HEPs i.e. plans for the Northern, Midland, Central and Southern regions are defined in the National Health Emergency Plan. Activation can be triggered by any of the Northern Region DHBs.
Tsunami or volcanic activity
Mass information service outage
Outbreak of significant communicable disease The NRHEP can be activated by notification from:
A DHB when responding to an incident that requires regional assistance, management and coordination where their resources are overwhelmed, or have the potential to be
The MoH when the NHEP is activated requiring DHBs to activate their HEP. This may be in response to a national incident or in support to another health region.
The Ambulance Communication Centre when an incident or potential incident requires or is likely to require a regionally coordinated response from DHBs and other service
Emergency Ambulance Communication Centre
St John national emergency management team have set up a single point of contact system with the 20 DHBs, in the form of an electronic paging/text notification to provide notification of a major event. The Counties Manukau Health single point of contact is the Duty Manager. This system is tested monthly.
Pathway for Notification and Activation of NRHEP and NRHCC
Health DHB (St John) EACC
CDEM Notification DHBs SPOC Activate No M O N I T O R I N G Yes DHB HEP MoH notification/ acknowledgement of code Is Regional Coordination required No Yes Regional Teleconference Regional Coordinator appointed NRHCC Regional response and planning activities Monitoring/ Regular Teleconferences Yes NRHCC CIMS structure established Need for escalation?
Any emergency has the capacity to reduce the workforce required to meet the needs of that emergency, which can lead to the transfer of staff from CM Health to another DHB, or have staff transfer from another DHB to CM Health.
Depending on the availability of staff with the necessary skills and qualifications, it is important to ensure that basic service levels are maintained. This can be done by reviewing a request either via Health EMIS or through current communication channels.
Requests from other DHBs concerning supplies / materials will be received by the IMT. Depending on the availability of the resources requested and ensuring the resources demands of the DHB are maintained. The receipt and management of resources or supplies from other DHBs or from national stockpiles will be coordinated through the Regional or National Coordinator with National Reserve Supplies will be distributed in accordance with MoH Policies and Guidelines.
Health Related Roles and Resources
Non-Governmental Organisations (NGOs)
Links to Non-Government Organisations (NGOs) are via the Auckland Region CDEMG in their Welfare Group Plan and associated connections. This linkage with NGOs is an area that needs to be reinforced through CDEMG and the Auckland Council Emergency Management Team.
Volunteers that work regularly for CM Health undergo occupational health checks prior to working onsite as required, and adhere to the CM Health policy at all times.
The management of spontaneous volunteers is a complex situation. Spontaneous volunteers can be a significant resource, but are often ineffectively used and can hinder emergency activities by creating health, safety, and security issues, distracting responders from their duties, and
interfering with ongoing operations. There is work underway at a regional level to determine the best way forward and to learn from the Christchurch earthquakes. Documents to assist with Spontaneous Volunteers include:
Spontaneous Volunteer Management Planning. Civil Defence Emergency Management
BEST PRACTICE GUIDE 2006
National Health Emergency Plan
Maori (Maaori) Health
Links with Maori (Maaori) Health are well established and are continuing to be further developed. There are approximately 90 000 Maaori whaanau in the CM Health district out of a total
population coverage of 510 000. Maaori whaanau make up 16% of the total district population. Support provided to Maaori whaanau by:
empowering them to develop their own health and support plan
strengthening, maintaining and sustaining relationships within Counties Manukau
working closely and collaboratively with integrated hospital staff as well as the community encouraging whaanau to advocate for themselves so their voices are heard
promoting the indigenous identity for Social Work and Nursing in Aotearoa and assisting Maaori as Tangata Whenua to obtain services adequate for their needs
Links with Pacific Health organisations are well established. There are approximately 117 000 Pacific people in CM Health district out of a total population coverage of 510 000. Pacific people
make up 23% of the total District population. More than 40% of New Zealand’s Pacific population live in CM Health district. CM Health Pacific team staff work closely with the PHOs, Pacific
Providers and churches.
Recent events highlighted several significant sectors of the population were at high risk from the effects of a disaster. These sectors include:
Documents to assist with these sectors include:
Best Practice Guidelines for engaging with Culturally and Linguistically Diverse (CALD) Communities in times of Disaster
Working Together; CDEM Sector (IS8/0)
Standing down the HEP
The date and time of the official stand down or deactivation of an emergency response will be determined by either the local or regional agency in consultation with the MoH.
Deactivation of an emergency response is dependent on a wide range of variables that must be satisfied before the announcement occurs. Some basic principles that should be followed are:
That the emergency response role has concluded.
That the immediate physical health and safety needs of the affected people have been met.
That essential health disability services and facilities are re-established and operational.
That the immediate health concerns arising from the public have been satisfied.
That it is timely to enter the active recovery phase.
Once confirmed, the MoH will issue a Code Green alert to signify the end of the response period. The time and date of deactivation may be used to determine arrangements implemented by the MoH in the recovery period.
After each activation/exercise the CM Health HEP is reviewed based on debriefings and evaluation outcomes in order to clarify roles and responsibilities at all levels during local, regional and national activation.
Section 5 Recovery
Recovery begins after the initial impact has been stabilised and extends until normal business has been restored. It may involve a local, regional, national health related response or it may involve a whole of government response involving economic, social and legislative issues.
Recovery is a complex social process and is best achieved when the affected community exercises a high degree of self-determination. Recovery extends beyond restoring physical assets or
providing welfare services. Successful recovery recognises that both communities and individuals have a wide and variable range of recovery needs and that recovery is only successful where all needs are addressed in a coordinated way. The timeframe for recovery may vary from weeks to years as economic and emotional effects can cause constant stress for many years. Recovery objectives include:
Minimising the escalation of the consequences of the emergency
Regeneration of the emotional, social and physical well-being of individuals and communities
Taking opportunities to adapt to meet the future needs of the community
Reducing future exposure to hazards and their associated risks.
CM Health – A Whole System Approach
An integrated whole systems framework is needed to consider the multi-faceted aspects of recovery which, when combined support the foundations of community sustainability. The framework used by MCDEM in its “Focus on Recovery: A Holistic Framework for Recovery in New Zealand” document that encompasses the community and the four environments: social,
economic, natural and built as illustrated.
Figure 10: An integrated whole systems approach to recovery
Built Environment Natural Environment Social Environment Community Economic Environment
Recovery encompasses the psychological and social dimensions that are part of the regeneration of a community. The process of psychological recovery from emergencies involves easing the physical and psychological difficulties for individuals, families/Whanau and communities as well as building and bolstering social and psychological wellbeing.
Psychological recovery is not limited to the recovery phase of an emergency event. Psychosocial recovery in the field of emergency management begins at the level of prevention through risk and reduction - Psychosocial Recovery Planning Guidelines: National Health Emergency Plan.
Psychosocial recovery spans the 4R’s of CDEM planning, with most emphasis on the readiness, response and recovery phases. It is just one element of wider social recovery, and also links to the other three components or recovery, namely of the economic, natural and built environments.
CM Health is committed to promoting health recovery measures, actions and operations not only during the recovery phase but across the 4R’s in its principles and organisational planning for all aspects of its emergency management planning.
To align with the requirements of the CDEM Act 2002, definition of recovery activities is the action that CM Health must undertake after an emergency and may include:
Assessment of the health needs of the affected community
Coordinating the health resources made available
Managing the rehabilitation and restoration of the affected community’s health care services and health status
Reassessing measures to reduce hazards and risks.
While the MoH and other government agencies may be the lead government involvement in a response phase (particularly in respect to a health emergency), it is usually MCDEM who becomes the lead government agency for coordinating any necessary government support for recovery. Large scale emergencies require a whole of government response. MCDEM coordinates the recovery activity of relevant CDEM groups, lifeline utilities i.e. electricity, telecommunications and water, government departments and international aid following the transition from response to recovery and during the short, medium and long term. More in depth information on recovery can be found in: Recovery Management Director’s Guidelines for CDEM Groups and the Guide to the National Civil Defence & Emergency Management Plan
The aim of organisational debriefing is for staff to communicate their experience of an emergency or exercise so that lessons can be identified. Plans are modified to reflect these lessons, to discuss best practice and improve the organisation’s ability to respond in future emergencies.
After each incident a review of the CM Health emergency response plans and procedures is carried out based on debriefings and evaluation outcomes. The model recommended by MCDEM, used by the MoH is outlined in Organisational Debriefing: Information for the CDEM sector (2006). Three types of organisational debriefing can be used to promote post-event learning. They are the hot or immediate post event debrief, the cold or internal organisational debrief and the
Reports from the debriefings are reviewed by all participants and agencies involved in the response. The purpose of the review is to analyse the existing plans and processes in place. The review will evaluate actions of all participants and their responses and may identify areas for improvement. Review and subsequent actions may require inter-agency collaboration. Review documents may become public documents. Plans will then be revised with the review findings, these new plans then require testing and validation by exercising to ensure that the lessons learnt have been effectively addressed.
Appendix 1: Abbreviations
Term Meaning in the HEP unless otherwise stated
Auckland DHB Auckland District Health Board
ARPHS Auckland Region Public Health Service
CDEM Civil Defence Emergency Management
CDEMG Civil Defence Emergency Management Group
CEG Coordinated Executive Group
CEO Chief Executive Officer
CIMS Coordinated Incident Management System.
CM Health Counties Manukau Health
DESC Domestic and External Security Coordination.
DHB District Health Board
EOC Emergency Operations Centre
EMS Emergency Management Service
EMIS Emergency Management Information System
A health emergency exists when the usual resources of the provider are overwhelmed, or have the potential to be overwhelmed.
Health CEG Health Coordinating Executive Group. Health CEG is responsible for coordinating emergency
management planning activities across the Northern Region
HEP Health Emergency Plan
Hospital IC Incident Controller. A member of a DHB emergency management team with overall
responsibility for coordinating emergency response at the individual DHB level
IMT Incident Management Team.
Liaison Officer Liaison Officers improve the flow of information by acting as single points of contact
MCDEM Ministry of Civil Defence and Emergency Management
MoH Ministry of Health
MIP Major Incident Plan
NGO Non-Government Organisation
NHCC National Health Coordination Centre
NHEP National Health Emergency Plan
NRHCC Northern Region Health Coordination Centre
NRHEP Northern Region Health Emergency Plan
ODESC Officials Committee for Domestic and External Security Coordination
OPF The Operational Policy Framework. Operational Policy Framework is a group of documents
collectively known as the “Policy Component of the District Health Board Planning Package” that sets out the operational level accountabilities for DHBs for each fiscal year.
PHO Primary Health Organisation
PHU Public Health Unit
PPE Personal Protective Equipment
Primary Care Care/services provided by general practitioners, nurses, pharmacists, dentists, ambulance
services, midwives and others in the community setting. Secondary/Tertiary
The levels of care provided in a hospital.
SPOC Single Point of Contact.
TAG Technical Advisory Group.
WDHB Waitemata District Health Board